Today, the health insurance system in the US is truly a disgrace:
About 15% of the US population, or 45 million people, lack health insurance.  The vast majority of the insured population are insured through their employers, or former employers, due to an historical quirk dating from WWII days.  The medical insurance industry offers up a crazy quilt of hard to compare plans, and the associated business costs are very high, perhaps 20-35% of all health care spending, depending upon what costs are counted.

Yet the basic insurance plan that people want is easy to understand, and fairly uniform: they want to be able to choose their doctor and specialists.  They want those doctors to be able to prescribe medical procedures and drugs as necessary to cure their disease, or ameliorate their suffering.  Unlike most products, demand is very inelastic: if you're sick, you want to be cured; if you're not sick, you want as little to do with the medical profession as possible.  All those ads you see on TV recommending regular checkups indicate that underuse,
rather than overuse, of the medical professions is the more typical problem.

Putting the onus on business to pay for health insurance is the wrong approach.  First, it limits the job mobility of anyone with a serious medical condition, especially to a small or startup company, since such individuals have to ensure that they'll be covered by the new company's insurance, and the company may be concerned that such individuals may trigger an increase the company's insurance rates.

Second, it adds significantly to the cost of creating news jobs, since employers have to budget the extra cost of their contribution to health insurance.  Democrats should promise to implement a plan with the following characteristics:

The simplest way to achieve these goals is with a Single Payer plan, where the Federal government provides a health insurance plan to all legal residents of the United States, paid for out of general tax revenues.  The pros are obvious: you get back a significant chunk of the ~30% administration costs that insurance plans require today.  The government can negotiate good prices with specialists, drug companies, and medical practices.  And many other countries have working plans that can be borrowed from (for example, France, most other European nations, and Canada).

I really, really, wanted this plan to be more competitive, based upon private insurance companies.  But virtually every alternative I looked at founders on the rocks of insurance company greed on one side, or individual greed on the other.  If we have private insurance companies, we have to guard against cherry picking: the tendency of the insurance companies to insure only healthy people.  The simplest way to prevent cherry picking is to require that any plan offered to anyone be offered to *everyone* who applies, on a first-come-first served basis, with no discrimination based upon pre-existing conditions.  Without this requirement, insurance companies will rationally do their best to avoid insuring people likely to cost them money: people with cancer (even, or especially, cancer in remission), diabetes, heart disease, or any one of an ever increasingly detectable number of genetic diseases will find it impossible to buy insurance.  And this last will only get worse over time: eventually, a DNA analysis will likely be able to give a good idea of all of an individual's future health problems.  Over time, an increasing number of losers in the genetic lottery will essentially be uninsurable from birth.

But if we prevent cherry picking by insurers by permitting individuals to join any insurance plan they want, when they want, then people will sign up for very restrictive and inexpensive plans while they're healthy, only to switch to more responsible and expensive plans if someone has need of more sophisticated treatments.  This is just as damaging to the health care industry as cherry picking, even though the beneficiaries are obviously different.

A single payer plan puts everyone in a single pool, solving this problem entirely.  Note also that nothing would prevent wealthier individuals from buying additional insurance that might cover untested experimental procedures, cosmetic surgery, or anything else not covered by basic health insurance.

How much would such a program cost?  This plan is essentially a tranfer of payments from employers, who currently pay most health care insurance premiums, to general tax revenues, with some differences.  First, there is additional spending due to the plan's providing insurance for the currently uninsured.  COBRA payments for a family of four these days is probably around $1000/month, or $3,000 per person per year.  Insuring 45 million people at this rate would cost abouit 135 billion dollars.  But this amount would be reduced by the cost to hospitals today of providing uncompensated care to walk-in cases, which probably will cost about $50 billion dollars in 2005.  And, if a single payer plan is followed, perhaps 2/3rds of the 20-30% paperwork overhead on the nation's health care costs, likely over 100 billion dollars, would be saved by having a single payer whose goal isn't the spurious rejection of claims to avoid payment.  The sum of these savings look, at first glance, to be higher than the additional cost of insuring the uninsured.  The program should also be a strong spur to job creation, since the marginal cost of adding a new job should drop by about $5,000 to $10,000 per person per year.

In summary, a single payer health insurance plan would make the economy more efficient, since people could switch jobs more easily. It would encourage job growth.  It would solve the major problem of those without health insurance today.  People would still be free to choose whatever doctors and hospitals they want for treatment, and their doctors would be free to prescribe whatever drugs they wish.  A huge milstone would be removed from employers, especially those who pay relatively paltry salaries.  And the plan is simple enough for nearly anyone to understand (as opposed to the Medicare Prescription Drug Benefit, for example).